PB2691: ARSENIC RETENTION IN TISSUES AND QUALITY OF LIFE IN PEDIATRIC ACUTE PROMYELOCYTIC LEUKEMIA TREATED WITH ARSENICALS: A CROSS SECTIONAL STUDY
Authors: Chao Wu, Changwen Xue, LI Zhang
Journal: HemaSphere (2023)

Topic: 35. Quality of life and palliative care Background: Acute promyelocytic leukemia (APL) is characterized by the formation of a PML-RARa fusion gene and almost curable disease with the use of all-trans retinoic acid (ATRA) and arsenicals, including arsenic trioxide (ATO) and Realgar-Indigo naturalis formula (RIF). Now, the purpose of patients is to pursue better quality of life. This cross sectional study is to determine the arsenic concentration in tissues and whether arsenic retention is negatively related to quality of life. Aims: To investigate arsenic concentration in tissues and health-related quality of life (HRQoL) in pediatric acute promyelocytic leukemia (APL) treated with arsenicals Methods: From 2017-5-12 to 2022-9-7, one hundred and twenty-six children with APL were enrolled in The Chinese Children’s Cancer Group study APL-2017(CCCG-APL-2017). This trial is registered with the Chinese Clinical Trial Registry, ChiCTR-OIC-16010014. A cross sectional study was started from 2022-7-11 to 2022-9-7. And thirty-six patients with APL were recruited into this cross sectional study. A total of 26 parents of children suffering from APL completed the Chinese Version of Pediatric Quality of Life Inventory 4.0(PedsQL4.0), which comprised physical, emotional, social and school. Thirty-six patients with APL and seventeen healthy children as control were included in the study to analyze the arsenic concentrations. Plasma, urine, hair and nail samples were collected to determine the arsenic concentrations applying inductively coupled plasma mass spectrometry (ICP-MS). PedsQL4.0 subscale scores between groups with different arsenic concentrations in tissue were compared using two independent-sample t-test. Analysis of variation (ANOVA) was applied to compare plasma, urine, hair and nail arsenic concentration between groups with different times of ceasing arsenicals combing control group, respectively. Results: Arsenic retention in plasma, urine, hair and nail from patients who had been off the arsenic-containing treatment for less than 3 months were higher than the controls, respectively. And statistical analyses revealed significant difference between the two groups. The arsenic levels in plasma, urine, hair and nail from two groups were, repectively,8.77±7.26 vs 2.51±2.29（P=0.005）, 225.56±325.39 vs 54.15±64.22（P=0.020）,3394.72±4126.71 vs 150.68±73.00（P=0.002）, 6925.67±4325.83 vs 313.74±308.32（P=0.001）. As showing in figure 1, if the patients had ceased arsenicals for more than 3 months, there was no significant difference in arsenic concentration of tissues between four groups. A total of 26 children suffering from APL treated with CCCG-APL-2017 protocol completed PedsQL4.0. Those data were analyzed. According to whether the arsenic concentration in tissue is higher than the control group, patients were divided into two groups, group A being higher than the control group, the other being group B. As showing in table 1, in the total score, physical, emotional, social and school of PedsQL4.0, there was no significant difference between group A and group B Summary/Conclusion: After the application of arsenicals (ATO and RIF), the level of arsenic concentration in tissues would be higher than normal for a period of time, and gradually return to normal. Moreover, arsenic residue in the tissues was not a factor affecting the quality of life in children suffering from APL treated with arsenicals.Fig.1 Arsenic concentrations in the plasma (A), urine (B), hair (C) and nail (D) samples obtained from the different groups. m, months. * indicates a P value less than 0.05 in a comparison with the control groupKeywords: Arsenic, Acute promyelocytic leukemia, Quality of life